What is the biggest public health “monster” in the Philippines and in the whole world now?

If your answer is the new coronavirus disease (COVID-19), you’re utterly mistaken.

COVID-19 has been getting all the media hype, scaring everyone out of their wits. Fact is, COVID-19 is not really the biggest and deadliest health hazard we should focus all our resources to control.

Definitely, we should allocate financial and other resources to treat COVID-19 cases and cut its spread, but we should not neglect the infectious disease killers that have been consuming our countrymen’s health for the longest time. Among them is pulmonary tuberculosis (TB).

TB kills 1.5 million worldwide yearly, and in the Philippines, 70 Filipinos die every day.

We need to sustain the initiatives which appear to be effective in TB control, and we need funds to keep the momentum going. Cutting the budget for TB control next year by P1 billion is definitely a big blow that can dissipate whatever gains that have been achieved in the last five years. What a big waste that would be!

The 65-member organizations of Philippine Coalition Against Tuberculosis (PhilCAT), along with TB advocates and survivors, wrote an urgent letter to Sen. Bong Go, chair of the Senate committee on health and demography, calling for the restoration of the TB budget for next year to maintain the National TB Program (NTP). The implementation of the Philippine Strategic TB Elimination Plan, Phase One, which started in 2018 and will be completed by 2023 will greatly suffer with the budget cut.

Long-term implications

“Any setbacks in control of the TB epidemic at this time will have devastating long-term implications of unnecessarily lost lives, and the rollback of achievements to the low levels of 2015,” the petitioners wrote.

Based on reports from the World Health Organization (WHO), an estimated 591,000 Filipinos were diagnosed with TB and more than 25,000 were killed in 2018. More than a third of Filipino households are seeking assistance from the government in the treatment of TB.

In the private sector, the average family, where a member has TB, is spending at least 20 percent of their annual household income for TB treatment, driving them further to worsening poverty. With the slashed household income due to the COVID-19 pandemic, this can really be a tough challenge to hurdle for the average household.

TB is not like other acute respiratory infections, where a one-week treatment with antibiotics would be sufficient to eliminate the bacteria. TB requires at least a six-month treatment with three to four drugs.

Due to financial constraints, many patients discontinue taking their medicines after a month or two when they start feeling better. Little do they realize that this premature discontinuation of treatment makes the TB mycobacteria in their lungs come back with a vengeance and more resistant to treatment.

The government committed to fund and treat 2.5 million TB cases by 2022. “For us to find TB cases, we need logistics to support case finding and treatment,” said Dr. Camilo Roa Jr., past PhilCAT chair and one of the prime movers of the anti-TB campaign in the country. He added that TB tests, treatment and prevention are all available and made affordable to high burden countries like the Philippines.

“Continuing to invest now as planned is less expensive than postponing and dealing with it later since by then, the number of infected and infectious persons will exponentially increase, thus more expensive to contain. Then we also have the issue of drug-resistant TB,” he explained.

According to Dr. Roa, there are now around 18,000 Filipinos with drug-resistant TB which costs 50 times more to treat. We can expect this to increase if the budgetary cut next year is not corrected.

Modeling studies of WHO and Stop TB Partnership, another global anti-TB alliance, indicate that the number of TB deaths is likely to rise rapidly because of the COVID-19 pandemic. PhilCAT is seriously concerned about this. If the 67-percent budgetary cut approved by the Department of Budget and Management (DBM) is not restored, the NTP will markedly suffer.

The NTP requires P3.6 billion yearly to effectively implement a responsive, patient-centered, integrated public health response to eliminate TB. Of this, the Department of Health has committed P1.5 billion for 2021. With P1 billion cut from the TB budget for next year, the current DBM-approved budget to support the NTP is only P502 million, which PhilCAT described as “sadly an all-time low for a high-burden TB country.”

Bigger bang for our buck

The alliance is concerned that this substantially threatens to reverse and undermine prior successes achieved before the COVID-19 pandemic. This amount can only procure first-line TB drugs for 243,385 adult Filipinos with TB per year, representing only 41 percent of estimated cases for 2021. So, more than half of TB cases might be untreated and this can dramatically increase the number of TB-resistant cases.

Stock levels of TB drugs may also start to decline next year, if not addressed soon enough. “There will be unnecessary delay in TB diagnosis and treatment, which will further amplify the unhampered spread of TB, facilitate the emergence of drug-resistant TB that is more expensive to control; and worse, will dramatically claim more lives,” the alliance warned.

That’s a pity, because TB is curable and preventable. COVID-19 is eating up a big chunk of the health budget this year and next year, but we can get a bigger bang for our buck in TB treatment and control.

Unlike in COVID-19, there are currently established rapid confirmatory tests, effective cure and preventive treatment for TB, made more affordable globally. “It has been estimated that for every peso spent on TB control, P44 come back,” said Dr. Roa.

He added that last year, TB killed 27,000 Filipinos, much higher than the annualized death rate for COVID-19. A year from now, we should expect our COVID-19 cases to go down, especially if a vaccine becomes available. But for TB, WHO predicts that our problem will even grow bigger due to the COVID-19 effect on our health-care system.

“Unless we sustain the push to end TB, we will have more TB deaths and more Filipino families becoming poor just because a household member was stricken with TB,” warned Dr. Roa. PhilCAT hopes that adequate legislation is passed to ensure that local government units allocate sufficient resources to support local implementation of TB program through universal health care in a devolved health-care system.

I join PhilCAT and other anti-TB advocates in fervently hoping that the DBM may be enlightened on the adverse impact the budgetary cut for the country’s anti-TB program would cause. It’s not too late. They can still correct it. What’s P1 billion compared to the thousands of lives it could save!

The message, though, is quite sad. It suggests that TB is regarded as a not-too-urgent health problem to worry about, so sound plans to finally eradicate it are not well understood, and appreciated. Or perhaps, it’s just not well communicated.

It seems that COVID-19 has a much better public and media relations manager than TB. INQ